General dental treatment - Continuation cases

Continuation cases for general dental treatment

If a course of treatment is started under one list number and completed under another list number within the same practice, then this is a continuation case. This process is a function of your Practice Management Software (PMS) and therefore general and technical support for these claims should be from your PMS support. 

The same date of acceptance must be used on all parts, to reflect that it is one course of treatment. The separate parts 1 and 2 (or higher) must be submitted in the correct sequence and it is advisable to allow at least 1 day between submitting the different parts. 

Your PMS maintains the patient charge, the patient’s exemption status and any prior approval granted on the part 1 claim by carrying it on to the part 2. This ensures the maximum patient charge is not breached, applies the correct exemption for the whole course of treatment and that treatment can continue for an approved case if the treatment plan is unchanged. 

If after you take over treatment on the part 2 you realise the proposed treatment has changed for either an existing prior approved case or where the combined cost of all parts of a continuation case is now above the prior approval limit,  you should stop treatment and amend the treatment plan on your PMS which will invite you to apply for approval or re-approval. 

Your PMS may request you to enter the claim number, Case ID, or DRS of the part 1 onto the part 2 claim and state what part number the claim is. There may also be a requirement to add prior approval details such as the date and 30-digit approval code onto the part 2 although some PMS may do this automatically. 

Do not enter any of the above information in observations. Use your PMS to manage these cases and enter details only in the specific data fields provided in your system. PMS systems may have variations of the same process, so we again recommend you take their advice and support.